Website Booking Provide an emergency first aid response in an education and care setting

Welcome to your Survey Monkey course booking form for HLTAID004.

Please complete the following survey monkey form which is also your course date booking form. Simply complete the information and submit your form at the end of the last question.

Thank you and have a great day.

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1.Your status

Mr

Miss

Ms

Other

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2.First Name

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3.Surname

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4.Email address

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5.Residential Address

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6.Suburb

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7.Postcode

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8.Contact number (mobile)

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9.Contact number (home)

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10.Gender

Male

Female

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11.Date of Birth

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12.Were you born in Australia

Yes

No

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13.Town of Birth

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14.If you were not born in Australia please specify country of birth

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15.Do you speak a language other that english at home

Yes

No

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16.How well do you speak english

Very well

Well

Not well

Not at all

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17.Are you of aboriginal or torres strait islander origin

No

Yes aboriginal

Yes torres strait islander

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18.Do you consider yourself to have a disability, impairment or long term condition

Yes

No

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19.If yes please indicate below

Vision

Learning

Hearing

Physical

Medical condition

Other

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20.What is your highest completed school level (tick one box only)

Year 12

Year 11

Year 10

Year 9

Year 8 or below

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21.In what year did you complete that school level

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22.Are you still attending secondary school

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23.Have you successfully completed any other qualifications

Yes

No

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24.What qualifications have you completed (if any)

Bachelor degree

Advanced diploma or associate degree

Diploma

Certificate IV

Certificate III

Certificate II

Certificate I

Certificate other than above

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25.What is your employment status

Full time employee

Part time employee

Casual employee

Employer

Not employed and not seeking work

Unemployed seeking full time work

Unemployed seeking part time work

Employed unpaid, working in a family business

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26.Study reason

To get a job

To develop my existing business

To start my own business

To try for a different career

To get a better job or promotion

It was a requirement of my job

I wanted extra skills for my job

To get into another course of study

For personal interest or self development

other reason

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27.Please insert your Unique Student Identifier number. If you do not have a USI please visit www.usi.gov.au and generate your USI.

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28.I would like to book into the following first aid course

11 January 2019 Southport

Thank you for completing your first aid course enrolment form. You are now booked into your first aid course. Once your payment has been made we will send you your login where you can complete your online component. Once that is complete you will be ready for the practical day which you have booked into. We will send you another email prior to your course day to remind you about your course including times and parking. Thank you and have a great day.

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29.Please acknowledge the below privacy notice Under the Data Provision Requirements 2012, Gold Coast Training College is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). Your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by Gold Coast Training College for statistical, regulatory and research and advertising purposes. Gold Coast Training College may disclose your personal information for these purposes to third parties, including: School – if you are a secondary student undertaking VET, including a school-based apprenticeship or traineeship; Employer – if you are enrolled in training paid by your employer; Commonwealth and State or Territory government departments and authorised agencies; NCVER; National Centre for Vocational Education and Research. Organisations conducting student surveys; and Researchers. Personal information disclosed to NCVER may be used or disclosed for the following purposes: Issuing a VET Statement of Attainment or VET Qualification, and populating Authenticated VET Transcripts; facilitating statistics and research relating to education, including surveys; understanding how the VET market operates, for policy, workforce planning and consumer information; and administering VET, including program administration, regulation, monitoring and evaluation. You may receive an NCVER student survey which may be administered by an NCVER employee, agent or third party contractor. You may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au). Student Declaration and ConsentI declare that the information I have provided to the best of my knowledge is true and correct. I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.